CMS 11th SOW CDI Project: Report, Improve, Collaborate TMF Quality Innovation Network Quality Improvement Organization

QIN-QIO Program’s Quality Approach

TMF QIN-QIO Regional Partners TMF has subcontracted with strong, experienced quality improvement partners to provide expert technical assistance and quality improvement support for participating providers across the region. Arkansas Foundation for Medical Care Primaris (Missouri) QIPRO and Ponce Medical School Foundation (Puerto Rico) TMF Health Quality Institute (Texas and Oklahoma) TMF Health Quality Institute has partnered with the Arkansas Foundation for Medical Care, Primaris in Missouri and the Quality Improvement Professional Organization, Inc. in Puerto Rico to form the TMF Quality Innovation Network Quality Improvement Organization (TMF QIN-QIO), under contract with the Centers for Medicare & Medicaid Services (CMS). The TMF QIN-QIO works with providers across all care settings to provide quality improvement services in the states of Arkansas, Missouri, Oklahoma and Texas, and the territory of Puerto Rico.

11th Statement of Work (SOW) QIN-QIO Map

Join the TMF QIN-QIO Website http://www.TMFQIN.org Provides targeted technical assistance and will engage providers and stakeholders in improvement initiatives through numerous Learning and Action Networks (LANs). The networks serve as information hubs to monitor data, engage relevant organizations, facilitate learning and sharing of best practices, reduce disparities and elevate the voice of the patient. Four key roles of the QIO permeate all QIN work: Champion local-level, results-oriented change Data driven Active engagement of patients and other partners Proactive, intentional innovation and spread of best practices that “stick” Facilitate learning and action networks Creating an “all teach, all learn” environment Placing impetus for improvement at the bedside level – for example, in the HAI work - hand washing Teach and advise as technical experts Consultation and education The management of knowledge so learning is never lost Communicate effectively Optimal learning, patient activation, and sustained behavior change

TMF QIN-QIO, continued Convenes stakeholders, providers and improvement experts in an “all teach, all learn” model Provides educational webinars and conferences, and encourages peer sharing, rapid testing of change ideas and support for adapting and spreading successful improvements Four key roles of the QIO permeate all QIN work: Champion local-level, results-oriented change Data driven Active engagement of patients and other partners Proactive, intentional innovation and spread of best practices that “stick” Facilitate learning and action networks Creating an “all teach, all learn” environment Placing impetus for improvement at the bedside level – for example, in the HAI work - hand washing Teach and advise as technical experts Consultation and education The management of knowledge so learning is never lost Communicate effectively Optimal learning, patient activation, and sustained behavior change

LANs Join any of the following TMFQIN.org networks and you can sign up to receive email notifications to stay current on announcements, emerging content, events and discussions in the online forums. Antibiotic Stewardship Nursing Home Quality Improvement Behavioral Health Patient and Family Cardiovascular Health and Million Hearts Quality Improvement Initiative Quality Payment Program Health for Life – Everyone with Diabetes Counts Readmissions Value-Based Improvement and Outcomes Immunizations Meaningful Use Medication Safety

11th SOW Nursing Home Clostridium difficile Reporting and Reduction Project Identify and recruit nursing homes in communities where there are increased rates of Clostridium difficile (CDI) Arkansas to recruit at least 34 nursing homes – 40 homes recruited as of Sept. 30, 2016 Support nursing homes in enrolling and monitoring CDIs using the National Healthcare Safety Network (NHSN) This becomes a way to measure the impact of antibiotic stewardship efforts in the future. Provide resources and education promoting antibiotic stewardship efforts in nursing homes Reduce harm from both antibiotic misuse and CDIs for residents across the country OIG report: Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries (OEI-06-11-00370), February 2014

Arkansas Hospitals with CDIs

CDI Harms Nursing Home Residents More than 80 percent of the deaths associated with CDI occurred among Americans aged 65 or older (CDC 2015). More than 100,000 CDI infections develop among residents in U.S. nursing homes each year (CDC 2015). 70 percent of CDI infection-related harm was preventable (OIG 2014). OIG report: Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries (OEI-06-11-00370), February 2014

CDI Harms Nursing Home Residents One out of nine patients 65 or older with a healthcare-associated CDI infection died within 30 days following their diagnosis (CDC 2015). Healthcare-associated infections, such as CDI, often result in considerable suffering for residents in long- term care facilities as well as increased cost for the healthcare system. (Advancing Excellence July 2015 Newsletter).

NHSN Long-Term Care Facility Component: Data for Action NHSN infection reporting is tailored for long-term care facilities and was released in September 2012. Approximately 250 nursing homes are currently enrolled. This offers standardized event criteria and data analysis across facilities. There are currently 40 homes completing NHSN enrollment in Arkansas and preparing to report CDI. The Centers for Medicare & Medicaid Services (CMS) expects 10 consecutive months of reporting to gather baseline for nursing home CDI. www.cdc.gov/nhsn/ltc

NHSN is new to nursing homes Barriers for nursing homes Benefits for nursing homes

New Infection Control Regulations in Nursing Homes The CMS final rule was released Oct. 4, 2016 https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-23503.pdf The new rule brings infection prevention to nursing homes. Antibiotic Stewardship will be implemented in Phase 2 of this new rule. An infection preventionist will be implemented by Phase 3 of this rule.

New Infection Control Regulations in Nursing Homes Nursing homes will now be required to develop an infection prevention and control program that includes antibiotic stewardship and at least one designated infection preventionist. This plan must be evaluated and updated annually.

What are the opportunities to prevent infections in nursing homes? Better recognition and communication Standardize the way infections are defined and reported to monitor the burden of the problem Improve documentation of the response Inadequate documentation of actions leads to incomplete information and missed opportunities Implementing best practices for prevention Facility practices to prevent infection should be monitored for adherence and impact

Recruited Arkansas CDI Nursing Homes 40 out of 228 nursing homes participating for a 17.5 percent participation rate for the state 31 out of 80 nursing homes from the high-risk group = 39 percent 2 out of 19 homes from the medium-risk group = 11 percent 7 out of 129 homes from low-risk group = 5 percent

113 nursing homes participating in the QIN-QIO 11th SOW 40 nursing homes participating in the QIN-QIO 11th SOW CDI project * Number of CDI nursing homes affiliated with an ACT coalition 4 CDI nursing homes not affiliated with an ACT coalition 2* 2* 6* 7* 2* 6* 3* 4* 3*

Collaboration and Communication Between Settings TeamSTEPPS training will be provided to participating nursing homes to facilitate communication between settings. Participating nursing homes will contribute to the national database on the prevalence of CDI. Nursing homes will benefit from networking and learning from others working together on this initiative. Community coalitions will work together on tools to reduce readmissions, including infection prevention protocols. Example of how we can work together

Open Discussion This material was prepared by TMF Health Quality Institute, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 11SOW-QINQIO-C2-16-82

For additional information, please email nhnetwork@tmf.org Contact Us For additional information, please email nhnetwork@tmf.org